What is the function of the gallbladder?

From the Guidelines

For patients with symptomatic gallstones, surgical removal of the gallbladder is the most advantageous treatment option because it removes the threat of gallbladder cancer and prevents future biliary complications or death. When considering treatment for gallstone disease, the primary goals are to prevent future biliary pain or prevent a future biliary complication or death 1.

Asymptomatic Gallstones

For asymptomatic gallstones, expectant management is recommended due to the low risk of major complications and the benign history of the disease 1. However, patients with a high risk for gallbladder cancer, such as those with calcified gallbladders or large stones (> 3 cm), may be exceptions to this recommendation and may benefit from prophylactic cholecystectomy 1.

Symptomatic Gallstones

In contrast, symptomatic gallstones require a more complicated treatment approach. The clinician should assess the patient's treatment goals and attitudes, determine if the biliary pain is the first episode, and estimate the natural history of the disease using natural history data 1.

• The patient's treatment goals and attitudes should be considered, including whether the patient wants to prevent another episode of pain.
• If the patient wants to prevent future episodes of pain, treatment options such as surgical removal of the gallbladder or other interventions should be considered.
• The natural history of the disease should be estimated using natural history data to inform treatment decisions. Surgical removal of the gallbladder is the most effective treatment option for preventing future biliary complications or death in patients with symptomatic gallstones. This is because it removes the source of the problem and eliminates the risk of gallbladder cancer, which is a potential complication of gallstone disease 1.

From the Research

Gallbladder Disease Overview

• Gallstone disease affects a significant portion of the population, with up to 20% of the European population and 10% to 15% of adults in the United States being affected 2, 3.
• Risk factors for developing gallstone disease include female sex, older age, certain medications, and having type 2 diabetes mellitus, nonalcoholic fatty liver disease, obesity, rapid weight loss, or hemolytic anemia 3.

Symptoms and Diagnosis

• Symptomatic gallstone disease usually presents as sudden onset right upper quadrant or epigastric abdominal pain 3.
• Ultrasonography is the initial imaging choice for detecting gallstones and acute cholecystitis 2, 3.
• A hepatobiliary iminodiacetic acid (HIDA) scan can be used to evaluate for cholecystitis in patients with negative or equivocal ultrasound findings 3.
• Magnetic resonance cholangiopancreatography (MRCP) is an accurate, noninvasive diagnostic test to identify choledocholithiasis, certain malignancies, and biliary obstruction 3.

Treatment Options

• Laparoscopic cholecystectomy is considered the most cost-effective management strategy in the treatment of symptomatic gallstones 4, 5, 2, 3.
• Cholecystectomy is indicated for patients with symptomatic gallstones or sludge, and should be performed laparoscopically with a four-trocar technique, if possible 2.
• Ursodeoxycholic acid (UDCA) is a bile acid that dissolves gallstones, but its use is not widely supported and more research is needed to determine its effectiveness 6.
• Nonsteroidal anti-inflammatory drugs are safe and effective in treating pain from acute cholecystitis and biliary colic 3.

Complications and Prevention

• Common complications of gallstones include cholecystitis, choledocholithiasis, gallstone pancreatitis, and ascending cholangitis 3.
• Regular physical activity and an appropriate diet are the most important measures for the prevention of gallstone disease 2.
• Early laparoscopic cholecystectomy within 24 hours of admission to hospital is recommended for acute cholecystitis 2.